Adolescent Suicide Risk Screening: A Secondary Analysis of the SHIELD Randomized Clinical Trial - 01/12/22
Abstract |
Objective |
To evaluate the effectiveness of adolescent suicide risk screening to increase initiation of mental health services via a secondary analysis using data from the SHIELD (Screening in High Schools to Identify, Evaluate and Lower Depression) randomized clinical trial, which evaluated school-based screening for major depressive disorder (MDD).
Study design |
Students in 14 Pennsylvania high schools were randomized by grade to either the usual school practice of targeted referral for behavior raising a concern for suicide risk or universal screening using the Patient Health Questionnaire-9 (PHQ-9), with any response >0 to item 9 regarding suicide risk considered positive. Students identified in either arm were referred to the Student Assistance Program (SAP), which is mandated in all Pennsylvania schools. The SAP determined follow-up. Study groups were compared using mixed-effects logistic regression.
Results |
The participants comprised 12 909 students, with 6473 (50.1%) randomized to universal screening. The study group was 46% female and 43% Hispanic or non-Hispanic Black. Adolescents in the universal screening arm had 7.1-fold greater odds (95% CI, 5.7-8.8) of being identified as at risk for suicide, 7.8-fold greater odds (95% CI, 4.6-13.1) of follow-up needs, and 4.0-fold greater odds (95% CI, 2.0-7.9) of initiating mental health treatment.
Conclusions |
Although the PHQ-9 is a MDD screening tool, its use in universal screening increased identification and treatment initiation for adolescents at risk for suicide. This confirms the value of universal screening and suggests that a suicide-specific risk assessment would have even greater impact on treatment initiation for identified youth.
Trial registration |
ClinicalTrials.gov: NCT03716869.
Le texte complet de cet article est disponible en PDF.Keywords : mental health, school-based screening, adolescent suicide
Abbreviations : ASQ, MDD, PHQ-A, PHQ-8, PHQ-9, RCT, SAP, SHIELD, USPSTF
Plan
| The research reported in this publication was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (AD-2017C3-8752).The views presented in this publication are solely the responsibility of the author(s) and do not necessarily represent the views of PCORI, its Board of Governors, or its Methodology Committee. Complementary yet distinct portions of the study are also supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) as part of an award totaling $900 000 (R40MC31765), with 0 percent financed from nongovernmental sources. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the US Government. The use of REDCap (Research Electronic Data Capture) in this project was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), through Grant UL1 TR002014. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Neither PCORI nor HRSA had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. J.W. has received research funding from NIH, Supernus, and Pfizer and consulted for Intracellular Therapeutics and Adlon Pharmaceuticals. J.K. reports grants from PCORI and the Agency for Healthcare Research and Quality during the conduct of the study and grants from Merck outside the submitted work. The other authors declare no conflicts of interest. |
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| Portions of this study were presented as a virtual live platform research presentation at the 2022 Annual Meeting of the Society for Adolescent Health and Medicine, Mar 10, 2022. |
Vol 251
P. 172-177 - décembre 2022 Retour au numéro
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